An association betwen migratory pulmonary infiltrates and peripheral eosinophilia has been known for at least 40 years. Diagnostic challenges still exist in the classifications within this syndrome. We describe a 33-year-old female without asthma but with definite ‘atopy’ who had a 4-year history of recurring pulmonary lesions. These were sometimes segmental, at other times dense and peripheral, and once there was lobar atelectasis due to mucoid impaction. Diagnosis by lung biopsy revealed eosinophilic pneumonia with bronchiolitis obliterans as a prominent feature. Steroid treatment resulted in prompt improvement; during a 5-year follow-up the infiltrates have not recurred but there has been persistent mild obstruction.
The effects of oxides of nitrogen inhalation are reported in a 21-year-old garexposed to silage gas. Initial nausea, cough and fever remitted, but respiratory failure developed 3 weeks later. Roentgenograms and lung function studies revealed pulmonary in the adult edema, volume restriction, and severely impaired gas exchange. Needle biopsy showed a nonspecific interstitial pneumonia. With steroid therapy all functional parameters except diffusing capacity returned to normal. Failure to inquire about non-occupational activities led to delayed diagnosis. A brief review of toxic effects of nitrogen oxides is presented.
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